Posted
by
Unknown Lamer
on Wednesday July 03, 2013 @09:37AM
from the 90s-dream-come-true dept.

ananyo writes "Two men with HIV may have been cured after they received stem-cell transplants to treat the blood cancer lymphoma, their doctors announced today at the International AIDS Society Conference in Kuala Lumpur. One of the men received stem-cell transplants to replace his blood-cell-producing bone marrow about three years ago, and the other five years ago. Their regimens were similar to one used on Timothy Ray Brown, the 'Berlin patient' who has been living HIV-free for six years and is the only adult to have been declared cured of HIV. Last July, doctors announced that the two men — the 'Boston patients' — appeared to be living without detectable levels of HIV in their blood, but they were still taking antiretroviral medications at that time."
The story reports that they have only been off of medication for seven and fifteen weeks and they won't know for a year, but signs are looking positive.

I remember recently there was some talk about research into curing some cancers by removing the patient's bone marrow, using HIV (ironically) to modify it, then transplanting that bone marrow back to the patient. What are the chances that something similar could be done here? To me it seems like all the pieces are in place; we know which gene confers some immunity, we are capable of editing targeted genes, and we can perform the bone marrow transplant. A marrow transplant would still be dangerous, but al

There's a good chance this 'cure' will kill the patent. It works, but it's dangerous. The choice is between a treatment that may kill you now, or a disease that will kill you eventually. And either way you'll get to take lots and lots of drugs with nasty side effects.

What's the insightful point here? This sentiment has been historically been raised in conversations about HIV as an excuse to not care about a disease that primarily affects homosexuals. It's far rarer that people say "Oh, well everyone has to go sometime" when discussing cancer research. So apologies if you're not being callous towards homosexuals with HIV, and are instead just making a trite observation that everyone dies.

Worldwide, HIV affects far more heterosexuals. While in developed countries, it is proportionally higher in homosexual men, almost 70% of people with HIV live in Sub-Saharan Africa. So if anything, I was being racist, not homophobic.
(In reality, I was being neither, instead merely trite.)

It's far rarer that people say "Oh, well everyone has to go sometime" when discussing cancer research

But more people should. When you consider how much money has been thrown at cancer and how little progress has actually been made (early detection is many times more important than any of the "advances" that have been made,) one has to wonder exactly how many ways that money could have been used to do some real good.

Agreed. I am diagnosed and being treated for an unrelated slow-onset disease, acromegaly (posting AC because of). This disease does not kill quickly.

So, you're an Acromegalic Coward? The "slow-onset" part feels a bit confusing, I've always thought that the most common early symptom is fast growth during puberty. If that's the case, the "slow onset" description seems a bit ironic.

Marrow transplants are dangerous, and there's no obvious way to go about making them safer. The problems are a fundamental result of the procedure itself, not simply a side effect. First, you must kill off the patient's bone marrow, there's simply no way around it since the bone marrow is what is causing the problem you are trying to treat. The only ways we know how to do that are with near fatal doses of chemotherapy or radiation. Actually, the doses are fatal, if they do what they are supposed to do and the patient doesn't receive their transplant they will die (when you donate there is a time period after the patient has had their marrow destroyed but before you actually donate, if you change your mind and decide not to donate during that time period the patient will almost certainly die unless another donor can be found and medically cleared in a matter of days). Then there's a period of not days, but weeks where the patient has no functioning immune system to speak of, not to mention severely limited red blood cell production. Then there's graft vs host disease where the immune system rejects it's new host body, essentially like organ rejection except in this case it affects the entire body. Then there's liver and kidney damage (both from the chemo and/or radiation and as a result of the transplant itself) and increased risk of cancer (not related to the original cancer being treated).

And that's all assuming that a suitable match can be found, which isn't guaranteed. A non-ideal donor increases the risk of complications, especially graft vs host (but can actually reduce the risk of cancer relapse interestingly). Part of the reason a donor can't always be found is that there simply aren't enough people on the registry, largely because people have this notion that donation is an extremely painful process. This was true in the past, but most donors now donate peripheral stem cells, where a drug (filgrastim) is given for a few days and donation is done through vein in the arm.

In the case of a cancer where marrow transplant is curative, there would be no way to be sure, but it will tend to be everywhere.

Note that this is distinct from stem cell rescue where the patient receives a drastic treatment for a non-marrow cancer that would destroy their marrow as a secondary effect. In those cases, they do donate stem cells to themselves.

Marrow transplants are dangerous, and there's no obvious way to go about making them safer. The problems are a fundamental result of the procedure itself, not simply a side effect. First, you must kill off the patient's bone marrow, there's simply no way around it since the bone marrow is what is causing the problem you are trying to treat. The only ways we know how to do that are with near fatal doses of chemotherapy or radiation. Actually, the doses are fatal, if they do what they are supposed to do and the patient doesn't receive their transplant they will die (when you donate there is a time period after the patient has had their marrow destroyed but before you actually donate, if you change your mind and decide not to donate during that time period the patient will almost certainly die unless another donor can be found and medically cleared in a matter of days). Then there's a period of not days, but weeks where the patient has no functioning immune system to speak of, not to mention severely limited red blood cell production. Then there's graft vs host disease where the immune system rejects it's new host body, essentially like organ rejection except in this case it affects the entire body. Then there's liver and kidney damage (both from the chemo and/or radiation and as a result of the transplant itself) and increased risk of cancer (not related to the original cancer being treated).

And that's all assuming that a suitable match can be found, which isn't guaranteed. A non-ideal donor increases the risk of complications, especially graft vs host (but can actually reduce the risk of cancer relapse interestingly). Part of the reason a donor can't always be found is that there simply aren't enough people on the registry, largely because people have this notion that donation is an extremely painful process. This was true in the past, but most donors now donate peripheral stem cells, where a drug (filgrastim) is given for a few days and donation is done through vein in the arm.

My brother-in-law is going through this right now, except he is acting as his own donor. They extracted some of his stem cells before the procedure, and have re-implanted them. He's in the immune system rebuild phase now.

(when you donate there is a time period after the patient has had their marrow destroyed but before you actually donate, if you change your mind and decide not to donate during that time period the patient will almost certainly die unless another donor can be found and medically cleared in a matter of days)

Umm, no.

Had this done last fall.

The Donor was donating before they started the chemotherapy on me. Until he'd provided enough stem cells, I just lay in the hospital bed getting nothing at all done....

They still do. Chemotherapy is quite dangerous and even in the best cases is pretty brutal on the patient. I've had the misfortune to see several people close to me go through chemo and it is an awful treatment with no guarantee of success. In some cases the chemo itself can be lethal.

Before the invention of the rat bastards at the AMA, it was said that with allopathic medicine you died of the cure, while with naturopathic medicine you died of the disease. IOW this has been a known quandary in medicine since long before you noticed. Cutting out a cancer might kill a patient, or they might live out the rest of a nice lifespan. Etc.

Looks like the same old garb to me. Dictators, monarchs, and bureaucrats have always promoted themselves as making better decisions for the good of their people. The key lies in the definition of "better". Tyrants adopt a policy that benefits themselves most, when what's needed is a policy that benefits everyone.

The existence of faults in a government does not mean it's worse than letting each person make indepentently bad decisions.

There's a good chance this 'cure' will kill the patent. It works, but it's dangerous. The choice is between a treatment that may kill you now, or a disease that will kill you eventually

It's a bit more complex than that, according to the article:

1. "The finding is very important for people with HIV who also need blood-cell transplants, but the treatment is unlikely to be used more generally because the risks from [allogeneic] transplants are high."2. "Their doctors think that an immune response called graft-versus-host disease — a post-transplant reaction in which donated cells kill off a patient’s own cells — may have then wiped out the patients’ HIV reservoirs, po

Are these the same stem cells that the Christian Right was trying to ban for research?

Not that I approve of the Christian Right, but I don't think so. These are bone marrow transplants that give blood stem cells from an adult donor. I think that the Christian Right are only against embryonic stem cell research

Yes, the thing that comes to mind is: Would a doctor encourage abortion more if they can harvest embryonic stems cells... or would they fertilize eggs and have them grow in the lab to be harvested later. If you view life beginning at conception (which many people do, not just Christians), this would be a huge ethically questionable act.

The previous "cure" was following a bone marrow transplant from someone with a mutation that made them highly resistant to HIV [nature.com]. This article makes it sound as though it was the transplant itself that cured the HIV. Does anyone know if these transplants also involved a resistant donor?

HIV levels go to undetectable in many HIV-drug patients, then reappear once off the drugs even if they have taken them over a decade. It was postulated there was a mystery resevoir for the virus. And/or it integrated into the victims DNA.

With Obamacare just around the corner...you are correct. We are ALL next.

First, you (or the other AC) attempted to blame the whole situation on homosexual -- a myth that HIV is from homosexual. The HIV is also from heterosexual as well (especially prostitution) and is under radar. Please take the bias out of the context.

Then you are pulling politic into the topic; whereas, there is no relation to the topic at all. So both posts of AC are flame bait.

Though they mostly were before, HIV transmission through that route is still not that bad. Now, IV drug use, that is where it spreads like wildfire. In fact, there is some speculation that bad drug policy which drove people to IV drugs and then to share needles that actually caused the first wave of the AIDS epidemic.

More than speculation. You can look it up in the American Journal of Public Health. That's pretty much the conclusion of all the researchers in the field.

In New York City around 1985, half the AIDS cases were gay men, and the other half were IV drug users. The public health people were fighting with the Giuliani administration (mayor) and the Pataki administration (governor).

This was nothing new. It was well-known that many infections were spread by IVDUs re-using needles. Hepatitis C probably caused more d

Something that strikes me as odd is half of all homosexual black men in the US have HIV. I mean think about that - for every 100 black gay men you see, about 50 of them have HIV. Nobody really understands why either, because apparently they don't behave any riskier than any other HIV demographic.

From an historical perspective: Covered wagon travel has become quite inexpensive, and costs a few bucks for a team of oxen, so it's not surprising to see a more expensive means of travel appear. A steam locomotive is a cash cow, with related costs adding up $15-30 USD.

Of course stem cell transplants are expensive now, but having a clear road ahead for AIDS treatment opens the door to future optimization and improvement. As the technique matures, it will become routine enough that the cutting-edge treatments you read about on Slashdot will indeed continue to be expensive replacements for current technologies, and those technologies will themselves become cheaper as they mature. Of course, as the cures mature and become part of every doctor's toolbox, the general public, including yourself, will cease to pay any attention to their dropping costs or minor improvements.

as long as there's money to be made in selling the treatment you can be sure there won't be a cure.

Such as with smallpox and rinderpest, right? Might as well include polio on the list as well since except for some pockets in Afghanistan and Pakistan, thanks to the Taliban and their distrust of modern medicine (like you apparently), polio is essentially gone from this planet.

Just think how much money these companies have lost by finding a cure for these afflictions rather than just treating them.

Not in Europe or other civilised places. In civilised countries, public health is studied by public research institutions at public universities.

We do this in America too - perhaps you've heard of the National Institutes of Health? But ultimately the actual drugs are made by private companies in most places, Europe included, because drug development is such a shitty business that most governments would (wisely) prefer to let someone else deal with it.

The cures for pandemics have never been a product of corporate research

Except that, to the extent that HIV is now largely survivable for those with access to the drugs, AIDS was cured by corporate R&D (aided, of course, by a lot of government-subsidized academic basic research). You can split hairs over whether protease inhibitor cocktails count as a "cure", but if you actually RTFA, maybe you'd understand why the pharma companies concentrated on making simpler treatments. Bone marrow transplants for

A patient of chemo for cancer will take many thousands of dollars each year to combat their disease, so this is where cancer treatment seems to have stalled out in the US.

Or maybe it's because treating cancer is insanely fucking difficult, because it isn't actually one disease but hundreds or thousands of different cellular regulation disorders which simply happen to have broadly similar effects, because really weeding out every last tumor cell would require therapies so drastic that they'd be likely to kill the patient, and because many cancers tend to evolve drug resistance over time. The costs of cancer go way beyond prescriptions for a few name-brand drugs (which aren't even available for everything); they include older therapies, hospitalization, and surgery. Insurance companies would save multiple hundreds of thousands of dollars per patient if there was a magic drug that cured cancer, and would happily pay a large amount for such a drug, so it's not like there's no profit to be had.

Isn't it interesting that "statist" national healthcare systems, pharmaceutical patent busting, publicly-funded medical research etc, has was, WAY better outcomes than the joke privatized hell that passes for a healthcare system in America?

In no small part those results are due to those state managed health care systems getting a free ride on the back of research conducted by US companies. 12 of the top 20 medical device companies are based in the US. The US spends about $140 billion on medical research each year (roughly half from industry, a third from government and the rest from various philanthropic organizations) and much of the rest of the world gets to avoid this cost. It's much easier and cheaper to wait for someone else to figure

Isn't it interesting that "statist" national healthcare systems, pharmaceutical patent busting, publicly-funded medical research etc, has was, WAY better outcomes than the joke privatized hell that passes for a healthcare system in America?

We have publicly-funded medical research in America too. In fact, it dwarfs most other countries, both in terms of money and productivity. The problem is that this research doesn't automatically lead to cures - developing new therapies is still extraordinarily expensive